Accuracy of MDCT in Predicting Site of Gastrointestinal Tract Perforation

Hainaux, Bernard; Agneessens, Emmanuel; Bertinotti, Raphael; Maertelaer, Viviane De; Rubesova, Erika; Capelluto, Elie; Moschopoulos, Constantin

doi:10.2214/ajr.05.1179

Cited by 203 publications

(132 citation statements)

References 14 publications

Supporting

Mentioning

106

Contrasting

Unclassified

Order By: Relevance

“…Artık günümüzde konvansiyonel laparotomi yerine endoskopik ve laparoskopik yardımcı yöntemler tedavi aşamasında artan oranlarda kullanılmaktadır. [2,3] Tedavi seçeneklerinin çeşitli olması ve acil karar verme zorunluluğu nedeniyle gö-rüntülemede yanıtlanması gereken temel soru perforasyonun yeri ve nedeninin ortaya konmasıdır. Doğru tedavinin planlanması için perforasyonun varlığı, yeri ve nedeni belirlenmelidir.…”

Section: Resultsunclassified

“…Gastrointestinal kanal perforasyonun yerini tanımlamada BT'nin doğruluğu %82-90 arasındadır. [1,3,6,7] Perforasyon yerine göre BT bulguları değişir ve bu bulgular perforasyonun yerini belirlemede faydalıdır. [8] Perforasyon yerinin duvar devamsızlığı şeklinde doğrudan gösterilmesi çoğu olguda mümkün değildir.…”

Section: Resultsunclassified

“…Hainaux ve arkadaşları [3] 4-slice MDBT ile 85 hasta ile ileriye dönük bir çalışma yapmıştır. Oral kontrast madde hiçbir hastada kullanılmamış, 46 hastaya intravenöz kontrast madde verilmiştir.…”

Section: Discussionunclassified

See 2 more Smart Citations

The Role of Abdominal CT in Determining Perforation Findings and Site in Patients with Gastrointestinal Tract Perforation.

Ilgar¹,

Elmalı²,

Nural³

2013

Ulus Travma Acil Cerrahi Derg

View full text Add to dashboard Cite

AMAÇBu çalışmada gastrointestinal kanal perforasyonlu hastalarda karın bilgisayarlı tomografisinin (BT) perforasyon bulguları ve perforasyon yerini belirlemedeki rolü araştırıldı. GEREÇ VE YÖNTEMTemmuz 2007 ve Temmuz 2010 tarihleri arasında, gastrointestinal kanal perforasyonu olduğu cerrahi olarak kanıtlan-mış 47 hastanın ameliyat öncesi karın BT görüntüleri geriye dönük olarak değerlendirildi. Her bir hasta için BT'de serbest hava, kontrast madde kaçağı, duvar kalınlaşması, duvar devamsızlığı, apse, flegmon ve serbest sıvı varlığı araştırıldı. Belirlenen bu bulgular ışığında perforasyon yeri tahmin edildi ve cerrahi sonuçlar ile karşılaştırıldı. BULGULARKarın BT bulgularına göre gastroduodenal perforasyonu olan hastaların %85,7'sinde, ince bağırsak perforasyonu olanların %85,7'sinde, kalın bağırsak perforasyonu olanların %69,2'sinde, rektum perforasyonu olanların %100'ünde, apendiks perforasyonu olanların %90,9'unda, tüm hastaların ise %82,9'unda perforasyon yeri doğru olarak belirlendi. Gastrointestinal kanal perforasyonunda BT'de en sık rastlanan bulgu %89,4 oranı ile karında serbest sıvı idi. Diğer bulguların rastlanma oranları ise sı-rasıyla şöyleydi; serbest hava %76.6, segmental duvar kalınlaşması %48.9, duvar devamsızlığı %25.5, apse %12.8, flegmon %10,6. Oral kontrast kullanılan 30 hastanın 7'sinde (%23,3) ekstraluminal kontrast kaçağı saptandı. SONUÇBT gastrointestinal kanal perforasyon bulgularını ve perforasyon yerini belirlemede oldukça etkilidir.Anahtar Sözcükler: Bilgisayarlı tomografi; intestinal perforasyon; spiral bilgisayarlı tomografi.

show abstract

Section: Resultsunclassified

See 1 more Smart Citation

The Role of Abdominal CT in Determining Perforation Findings and Site in Patients with Gastrointestinal Tract Perforation.

Ilgar¹,

Elmalı²,

Nural³

2013

Ulus Travma Acil Cerrahi Derg

View full text Add to dashboard Cite

show abstract

“…MDCT can accurately depict the site of gastrointestinal tract perforation in 86% of cases (13). Extraluminal air bubbles, segmental bowel thickening and focal defect of the bowel wall are strong predictors of the site of perforation (13).…”

Section: A B a Bmentioning

confidence: 99%

Cortisone associated diverticular perforation

Goethals¹

2011

Journal of the Belgian Society of Radiology

View full text Add to dashboard Cite

Steroid associated diverticular perforation is a rare, potentially lifethreatening complication of glucocorticosteroid therapy, associated with a high mortality and morbidity rate. Glucocorticosteroid (GCS) use induces both an increased risk for perforation, and a delay in diagnosis, secondary to the mitigated clinical presentation of peritonitis. Case reportA 55-year-old man, who recently received high dose intravenous GCS therapy (3 x 500 mg of methylprednisolone) for an acute relapse of Multiple Sclerosis, presented himself at the emergency ward, suffering from dyspnea and abdominal discomfort. A chest X-ray demonstrated clear signs of a pneumoperitoneum with air under both diaphragms (Fig. 1A, B). The patient had no history of recent abdominal surgery nor blunt or penetrating trauma. C-reactive protein levels were elevated (67 mg/L, normal values < 5 mg/L) and there was a neutrophilic leukocytosis (16 x 10 3 white blood cells / mm 3 , 76% neutrophils). An abdominal CT scan, performed after intravenous administration of iodinated contrast, confirmed the presence of free intraperitoneal air and demonstrated diverticulosis of the recto-sigmoid with overt signs of diverticulitis and a pericolic abscess collection due to a ruptured diverticulum ( Fig. 2A, B) The patient was treated by emergency Hartmann surgery, confirming the perforated colon and abscess collection. Postoperative recovery and wound healing was without complications, despite the GCS therapy and the DiscussionAlthough this case demonstrates evident radiological signs of a peridiverticular abscess with perforation, there was a vast radio-clinical discrepancy. Both the etiology of the intestinal perforation and this paucity of symptoms can be explained by the patient's history.GCSs are known to be positively associated with an increased risk of patient returned home 6 days after surgery with planned closure of the colostomy. JBR-BTR, 2011, 94: 348-349. Patients on glucocorticosteroid therapy are at increased risk of gastrointestinal perforation. The associated morbidity and mortality of perforations in this group is increased, compared with normal groups. This difference is due to the delay between onset of clinical symptoms and treatment. In the presence of steroids, gastrointestinal perforation is more difficult to diagnose clinically because signs and symptoms of perforation are masked by the anti-inflammatory effect of the steroids. CORTISONE ASSOCIATED DIVERTICULAR PERFORATION

show abstract

“…Previous studies, conducted predominantly in nontraumatic populations, have documented that CT can accurately predict the site of GIT perforation (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). However, nearly all literature is focused on nontraumatic GIT perforation secondary to ischemia, malignancy, and inflammatory conditions (18-21, 23-25, 28-31).…”

mentioning

confidence: 99%

Can multidetector CT detect the site of gastrointestinal tract injury in trauma? – A retrospective study

Kumar¹,

Gamanagatti²,

Das³

et al. 2017

Diagn Interv Radiol

View full text Add to dashboard Cite

T raumatic gastrointestinal tract (GIT) injuries are uncommon, representing less than 10% of all injuries in trauma patients (1), with a higher incidence in penetrating rather than blunt trauma (2). Small bowel is the most common site of alimentary tract injury in trauma followed by colorectal injuries, while gastroduodenal injuries comprise less than 2% of all injuries in trauma (3). In the current scenario of preferential nonoperative management in trauma, detection of GIT injury remains an important indication for urgent laparotomy as delayed diagnosis and surgery are associated with high morbidity and mortality (4). Also the type of operative management, prognosis, and outcome vary according to the number and site of GIT injuries (5).Multidetector computed tomography (MDCT) is a proven diagnostic modality for detection of traumatic GIT injuries with a reported sensitivity of 70%-95% and specificity of 92%-100% (6-11). Various CT signs of GIT and mesenteric injuries have been described such as bowel wall discontinuity, extraluminal air (either free or perivisceral), bowel wall thickening, abnormal bowel wall enhancement and intramural air, while mesenteric signs include mesenteric infiltration, active vascular contrast extravasation, beading, and abrupt termination of mesenteric vessels. These signs have reportedly variable incidences, sensitivities, and specificities; but if present, can lead prompt laparotomy and surgical exploration of the GIT to look for direct evidence of injury (12)(13)(14)(15)(16).MDCT with its capabilities of fast scanning, thin-section acquisition, and multiplanar reformatting has greatly enhanced the potential for detecting direct evidence of bowel in- 29From the Departments of Radiology (A.K.  dratinkumar@gmail.com; A.P., S.G., R.D., S.P.) and Surgery (A.G., S.K.), Jai Prakash Narayana Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India. E M E R G E N C Y R A D I O LO G Y O R I G I N A L A R T I C L E PURPOSEWe aimed to assess the performance of computed tomography (CT) in localizing site of traumatic gastrointestinal tract (GIT) injury and determine the diagnostic value of CT signs in site localization. METHODSCT scans of 97 patients with surgically proven GIT or mesenteric injuries were retrospectively reviewed by radiologists blinded to surgical findings. Diagnosis of either GIT or mesenteric injuries was made. In patients with GIT injuries, site of injury and presence of CT signs such as focal bowel wall hyperenhancement, hypoenhancement, wall discontinuity, wall thickening, extramural air, intramural air, perivisceral infiltration, and active vascular contrast leak were evaluated. RESULTSOut of 97 patients, 90 had GIT injuries (70 single site injuries and 20 multiple site injuries) and seven had isolated mesenteric injury. The overall concordance between CT and operative findings for exact site localization was 67.8% (61/90), partial concordance rate was 11.1% (10/90), and discordance rate was 21.1% (19/90). For single site localization, concordance...

show abstract

Accuracy of MDCT in Predicting Site of Gastrointestinal Tract Perforation

Abstract: MDCT is highly accurate for predicting the site of gastrointestinal tract perforations. Three of eight CT findings significantly correlate with surgical diagnosis.

Cited by 203 publications

References 14 publications

The Role of Abdominal CT in Determining Perforation Findings and Site in Patients with Gastrointestinal Tract Perforation.

The Role of Abdominal CT in Determining Perforation Findings and Site in Patients with Gastrointestinal Tract Perforation.

Cortisone associated diverticular perforation

Can multidetector CT detect the site of gastrointestinal tract injury in trauma? – A retrospective study

Contact Info

Product

Resources

About